An Episcopal (Anglican) Chaplain in the Saint Luke's Health System of Kansas City, reflecting on work and faith and life. NOTA BENE: my opinions are my own and do not represent the Episcopal Church or the Saint Luke's Health System.

Thursday, April 29, 2010

My newest piece is up today at Episcopal Cafe. It is in fact my third reflection on Michael Poon’s paper on the Communion and Covenant, “The Anglican Communion as Communion of Churches: on the historic significance of the Anglican Covenant.” Earlier posts are here and here. As you will see in this last piece, I am no longer hopeful about the Anglican Communion in its current (already altered) form. So, take a look and take some thought, and leave a comment. This continues to be an important topic for us in the Episcopal Church, whatever happens with the Anglican Communion and the Anglican Covenant.

Tuesday, April 20, 2010

Last week I posted from the APC Annual Conference in Schaumburg about “The Case of for Standards of Practice: Do Professional Chaplains Practice What They Preach?” a plenary presentation by George Handzo and Paul Derrickson. In that presenatation, George Handzo mentioned two blogsites by name. He considers them important sites for chaplains to read and, more important, to comment. He sees that as an important way for chaplains to participate in conversations to which we would bring an important (and on these sites welcome) perspective. He even stopped me later, knowing about my own blogging avocation, and said, "Go there. Start commenting."

Well, I'll see his two sites and raise two - sort of. The two sites he mentioned I already knew, and had already read. The first is "GeriPal - A Geriatrics and Palliative Care Blog." Geripal's contributors describe it as "a forum for discourse, recent news and research, and freethinking commentary." Further, they are explicit that "We aim to be inclusive. We welcome the perspectives of generalists, specialists, gerontologists, palliative care clinicians, and anyone else interested in care of the elderly or palliative care." Certainly, they welcome the contributions of chaplains.

The second is "Pallimed: a Hospice and Palliative Medicine Blog." The contributors to Pallimed are also inclusive: "Our target audience is the professionals (MD, DO, RN, LPN, LVN, Home Health Aide, ARNP, SW, Chaplain, Administrators, PT, OT, Speech, Pharmacy, etc.) working in hospice & palliative medicine, but we welcome all readers to this blog, including patients, families and other medical professionals outside of this field." Since they want to include us specifically, it's only good grace for us to make our contributions.

Having cited those two sites, let me suggest two others. These will take a bit more work. They're blog carnivals, collections of blog and web articles around a general theme (and sometimes a specific sub-theme) that are gathered periodically and hosted on various sites. Each issue of the blog carnival has links to articles on various blogs and sites, often with an introductory comment. The reader can then go to each article, read, and usually comment. Since a blog carnival is hosted by a different site each week, it can take a bit to find them, but it's worth the effort. The easiest way? Toward the end of each issue the host notes who will host the next issue. Just keep linking through until you catch up.

The first of these is "Grand Rounds." It rotates weekly, and each host has the opportunity to take all comers, or to narrow the focus to a more specific theme. If you've been a reader here for a while, you'll have seen already that now and again submit something from this blog. I think "Grand Rounds" is always worth checking out. Fortunately, one "Grand Rounds" participant has made the effort to keep track and so make it easier for the rest of us to find. This week, it's at The Sterile Eye.

The second blog carnival I'd point to is "Palliative Care Grand Rounds." It's posted the first Tuesday of each month, and is currently here. Folks involved iin both Geripal and Pallimed are also involved in "Palliative Care Grand Rounds," so we can trust it will also provide some interesting links for us. Now, as far as I know, no one is keeping track in one place where to find it each month. However, next month "Palliative Care Grand Rounds" will be hosted here.

I certainly agree with George that this is a way to share the voices of chaplains among a much wider group of professional colleagues. Oh, and for my APC colleagues: note the title and the time it takes to read. These articles can be considered professional reading in our Continuing Education records. So, take some time to do some reading on line, and commenting at these various sites (or at sites that are included in a blog carnival).

Wednesday, April 14, 2010

I was informed last night that several people have tried to access the AEHC Web Site and have seen a screen saying "Account Suspended." When I checked, I had the same experience. It seems we've had a difficulty paying our web host. Some of that is our fault in AEHC, and some difficulties in the online payment system the host has set up. Please know that we are working to resolve this issue as quickly as possible. In the meantime, I'll make sure I post any information necessary for AEHC here.

Correction: Since posting this last night the problem has been corrected, and the AEHC web pages are back up.

Tuesday, April 13, 2010

So, here it is, Tuesday morning, and we’re more than halfway through the Association of Professional Chaplains (APC) Annual Conference. The theme of this year’s conference is “Reaching New Heights.”

The theme has been, more and more using tools that are new and unfamiliar to most of us in the field: research, measuring, and standards. Now, those of you who read here regularly will know that those concepts aren’t new or unfamiliar to me. I’m a great believer in both. That said, an ongoing theme in both responses to presentations and in thoughts overheard in passing, is “How do we do this?” The “this” may be as small as a specific end, say, addressing compassion fatigue of staff; or as large as addressing the new Standards of Practice that have been put forward by APC’s Commission on Quality.

I would encourage folks to go to the APC web site once the conference is over and look at the various offering available on CD and DVD. I’m going to buy several myself, even thought I’ve been present for most of them. However, if you are a chaplain and you wanted to get just one, I would download “The Case of for Standards of Practice: Do Professional Chaplains Practice What They Preach?” (Go here and scroll down for a description.) The named presenters are George Handzo and Paul Derrickson, both speaking and serving as a panel responding to one another and questions from the audience. There are also presentations from leaders in APC discussing the history and processes of developing the Standards of Practice. I think we need to listen to the various voices in the presentation, perhaps reflecting on them one at a time to see how we react. We need to do this in context of reading and reflecting on the Standards of Practice.

I am not certain myself about these new Standards. Note that I’m not uncertain about having Standards of Practice. I’m uncertain about these Standards. How will we live with, how will we manifest these Standards?

Actually, the speakers make clear in this conversation that there is something of an “adoption” process for us as chaplains. There will be opportunities for feedback through the APC website and through workshops at future APC Conferences that can contribute to refinement. In addition, the Quality Commission has committed to a complete review of the Standards ever two years. With that promise, it’s clear to me that we’re not confronted with a new set of prescriptive rules that we called to meet, but with a set of descriptive parameters to which we aspire and within which we model our work globally.

That said, I’m alert to how other professions are affected by the Standards of Practice. I have been in meetings considering disciplinary action because a given patient interaction didn’t meet “standard of care.” That “standard” may be shaped by the standards of practice and the codes of ethics of a professional organization, and/or by state regulations. We may – arguably, we will – find ourselves in cases of disciplining chaplains for not meeting “standards of care.” In fact that’s why I was in one of those meetings. As we adopt references and standards, we will certainly be held to them, at times in ways we will find uncomfortable.

Nonetheless, this is an important step in our profession, and this presentation is an important beginning to the conversation. Give a day or two, and look up the recordings available. I think this will be on well worth having.

Tuesday, April 06, 2010

On March 17th I was invited to a conference on Advance Directives, sponsored by the Center for Practical Bioethics. The purpose was to discuss the status of Advance Directives, Advance Care Planning, Physician Orders for Life Sustaining Treatment (POLST) programs and similar efforts, and preparations for National Healthcare Decisions Day, Friday, April 16th.

After the conference I was invited to participated in taping a podcast about the morning's conference, about National Healthcare Decisions Day, and about Center resources on the topic. The podcast was initially circulated locally to the Center's Ethics Consortium, a gathering of representatives from area Ethics Committees. However, they have now made it available at their blog, Practical Bioethics. If you'd like to take a few minutes (all right, eleven minutes) and listen, you can do that here.

Take a moment to look at the resources available from the Center. I can highly recommend them for National Healthcare Decisions Day, and for any other setting where the topic is Advance Directives and Advance Care Planning.

Friday, April 02, 2010

In my first experience in hospital chaplaincy, back when I was still in seminary, I preached a sermon in the hospital chapel. I was young and stupid, and it showed in the sermon. The sermon was tense and anxious, and for at least one viewer in the hospital, it was offensive.

As I processed this fact and this sermon with my Supervisor, I began to realize just how anxious I was. I began talking about all the things on my mind, all my concerns, all the things I thought I was responsible for. In the midst of this, my Supervisor said something that stopped me cold, and brought me to tears. “You seem to feel that you have to be responsible for all the cares of the world. You can’t. That job’s already taken.”

That’s what Good Friday is about. That job is taken. Oh, the world is surely a troubled place, and as near as we can tell, we’re responsible for a lot of the trouble. Sure, we can talk about how creation is fallen, and how control is an illusion. But the truth is that we still see all the cares and concerns in the world; and we still see them as our responsibility.

There’s some comfort in that thought, really. That’s why we hold onto it. If we’re in control, perhaps we can do something about it. If we’re responsible, perhaps we can take responsibility and make things better.

Well, perhaps: some days we do seem to make some progress, to make things better, at least within our own small corners of the world. But then another day comes, and another event happens, and it all seems literally to have gone to Hell in a handcart.

And that’s without really thinking about the whole world. The minute we start thinking beyond our own small corners, and begin realizing just how much trouble there is in the world, we’re just as likely to despair. There’s no way we can do it. However responsible we might try to be, there’s no way we can make it all right. And once again, we end up feeling both the weight of all the troubles of the world, and a profound awareness of just how powerless we are.

But, that job is taken. That’s the message of the Cross. That’s the point of Jesus’ sacrifice. As troubled as the world is, it is not ours to make right. As fallen as Creation appears, it is not ours to make whole. Yes, we are powerless; but God is not. Yes, we despair; but God does not. Yes, we can’t help ourselves, much less the whole world; but God can, and God did. On the hill of the Skull, on a hard wooden cross, God the Son of God took the concerns of the world off of us, and took them on himself.

It is still Good Friday. The world looks desolate from the foot of the Cross, and, for that matter, from everywhere else we look. There are still days left to go before we see fulfilled what we can only hope for now. But while we watch and wait, consumed with sadness and anxiety, we can also trust. With all the concerns we have, with the opportunities we have to share in it, making the world right is not our responsibility. As difficult as things look, even when we have had our share of making things difficulty, repairing it all is not our responsibility.

That is the Gospel of Good Friday, the message of God on the Cross: that job is taken, and restoration has already begun.

Thursday, April 01, 2010

There’s a reason that I have styled these responses to Dr. Poon’s paper “reflections.” It is that I am not the scholar that Dr. Poon is (as kind as he’s been in his interest in my opinion), and his paper certainly deserves a proper scholarly response.

However, I also appreciate the value of responses that are thoughtful but not scholarly. For several years I was a member of the Internal Review Board in the hospital where I worked. While I developed over time some expertise in the informed consent process, the scientists made clear that they also appreciated “questions from ignorance.” Occasionally I did raise something they hadn’t thought about, but more often I helped them see what they needed to explain in greater detail.

With that in mind, several questions from ignorance have come to mind. The first is to look at the historical review. Dr. Poon begins at a familiar point: “Two ecclesial actions precipitated the present disputes. In 2002, the Diocese of New Westminster decided to authorize services for same-sex unions. In 2003, the Episcopal Church (USA) appointed a priest in a committed same-sex relationship as one of its bishops.”

Beginning with those events makes some sense, but I wonder if others wouldn’t make just as much. For example, what might it have meant to begin with Lambeth 1998, and specifically with the events around Lambeth resolution 1998-1.10. This shaped the context within which subsequent events occurred. What might that context have looked like had a different report on human sexuality been presented? It has been reported that there was a report that was displaced by resolution 1.10. What might that context have looked like had all provincial/national churches actively engaged in the listening, assurances and pastoral ministry to gay and lesbian persons enjoined in items c. and d. of resolution 1.10? What might that context have looked like if no measure had been passed, and Resolution 64 of Lambeth 1988 were to stand, reaffirming a call from Lambeth 1978 (Resolution 10) for “deep and dispassionate study of the question of homosexuality, which would take seriously both the teaching of Scripture and the results of scientific and medical research,” and in light of that calling for “each province to reassess, in the light of such study and because of our concern for human rights, its care for and attitude towards persons of homosexual orientation?” Interpretation of, and actions based on those interpretations of Lambeth 1.10 (both its content and its authority) would seem significant for understanding the import for the Communion of events of 2002 and 2003, as well as the Singapore ordinations and formation of the Anglican Mission in the Americas in 2000.

Here’s a second question. There are differences of opinion about the authority of the Windsor Report, and about the Report of the Windsor Continuation Group. Both were produced by bodies appointed by the Archbishop of Canterbury, and the Windsor Report was received by the Primates Meeting at Dromantine, while the WCG Report was received by the recent meeting of the Anglican Consultative Council. However, there are also differences of opinion about the authority of the See of Canterbury and of the other Instruments. Indeed, Dr. Poon’s paper refers to differing views on Canterbury in paragraphs 21 and 22. These differences would also seem to affect understandings of the Windsor Report and the WCG Report as normative documents for the Communion.

It would seem to me that it is in fact a theological project – an ecclesiological project – to describe appropriately the authority of the See of Canterbury, as well as the other Instruments, in relation to the member churches. There have been numerous statements in Lambeth resolutions about the limitations of Lambeth, from the first meeting. A number of Archbishops of Canterbury, Rowan Williams included, have made clear their own senses of the limitations on their jurisdiction. It would seem a theological project, and not a management project, to determine and offer for reception understandings of the forms and limits of authority of the various Instruments.

That is, as Dr. Poon notes, the direction given by the Anglican Consultative Council to the Inter- Anglican Standing Commission on Unity, Faith and Order (IASCUFO):

to undertake a study of the role and responsibility in the Communion of the Archbishop of Canterbury, the Lambeth Conference, the Anglican Consultative Council and the Primates’ Meeting; the ecclesiological rationale of each, and the relationships between them, in line with the Windsor Continuation Group Report (Resolution 14.09g)

Is there not, then, grounds to wait and see the results of this work, and to offer that for reception, as critical to understanding relations in the Communion generally, and the functions of the Instruments specifically? Would not this work offer our best or at least our first interpretive lens for the Covenant’s descriptions of the Instruments and their roles?

Now, Dr. Poon has a concern about the next resolution from the ACC meeting:

The Anglican Consultative Council, in the light of the Resolution 14.08 of ACC-14 on the WCG Report, asks that the report of the study undertaken by IASCUFO includes a study of the existing papers developed within our Communion and of current best practices in governance for multi-layered complex organizations, and makes recommendations to ACC-15 on ways in which the effectiveness of the Instruments of Communion may be enhanced. (Resolution 14.10)

His interpretation is that the theological project will be undermined if not actually displaced by a managerial treatise. He comments, ““Best practices” and “enhancement” are corporate-world speak. This Resolution took a managerial view of the instruments. But ecclesial deficit and corporate failing are two different matters altogether.” Granted; but perhaps the theological review and the managerial review are not mutually exclusive. It seems unlikely that the Communion will cease to be multi-layered and complex, whatever the results of the theological work. Even with this concern, wouldn’t our historic practices of reception within the Communion suggest waiting to see the IASCUFO report before dismissing it?

I’m sure I’ll have other questions from ignorance, but these seem like reasonable questions to start with.